活体肾捐献术后围手术期死亡率和长期生存情况。

Perioperative mortality and long-term survival following live kidney donation.

机构信息

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.

出版信息

JAMA. 2010 Mar 10;303(10):959-66. doi: 10.1001/jama.2010.237.

DOI:10.1001/jama.2010.237

PMID:20215610

Abstract

CONTEXT: More than 6000 healthy US individuals every year undergo nephrectomy for the purposes of live donation; however, safety remains in question because longitudinal outcome studies have occurred at single centers with limited generalizability. OBJECTIVES: To study national trends in live kidney donor selection and outcome, to estimate short-term operative risk in various strata of live donors, and to compare long-term death rates with a matched cohort of nondonors who are as similar to the donor cohort as possible and as free as possible from contraindications to live donation. DESIGN, SETTING, AND PARTICIPANTS: Live donors were drawn from a mandated national registry of 80 347 live kidney donors in the United States between April 1, 1994, and March 31, 2009. Median (interquartile range) follow-up was 6.3 (3.2-9.8) years. A matched cohort was drawn from 9364 participants of the third National Health and Nutrition Examination Survey (NHANES III) after excluding those with contraindications to kidney donation. MAIN OUTCOME MEASURES: Surgical mortality and long-term survival. RESULTS: There were 25 deaths within 90 days of live kidney donation during the study period. Surgical mortality from live kidney donation was 3.1 per 10,000 donors (95% confidence interval [CI], 2.0-4.6) and did not change during the last 15 years despite differences in practice and selection. Surgical mortality was higher in men than in women (5.1 vs 1.7 per 10,000 donors; risk ratio [RR], 3.0; 95% CI, 1.3-6.9; P = .007), in black vs white and Hispanic individuals (7.6 vs 2.6 and 2.0 per 10,000 donors; RR, 3.1; 95% CI, 1.3-7.1; P = .01), and in donors with hypertension vs without hypertension (36.7 vs 1.3 per 10,000 donors; RR, 27.4; 95% CI, 5.0-149.5; P < .001). However, long-term risk of death was no higher for live donors than for age- and comorbidity-matched NHANES III participants for all patients and also stratified by age, sex, and race. CONCLUSION: Among a cohort of live kidney donors compared with a healthy matched cohort, the mortality rate was not significantly increased after a median of 6.3 years.

摘要

背景：每年有超过 6000 名美国健康个体接受肾切除术以进行活体捐赠；然而，由于长期结果研究仅在单一中心进行，且具有一定的局限性，因此安全性仍存在疑问。

目的：研究活体供肾者选择和结局的全国趋势，评估各种活体供者人群的短期手术风险，并将长期死亡率与尽可能与供者人群相匹配且尽可能无活体捐赠禁忌证的非供者队列进行比较。

设计、地点和参与者：活体供者来自美国于 1994 年 4 月 1 日至 2009 年 3 月 31 日期间纳入的强制性全国活体肾供者登记处中的 80347 名活体肾供者。中位（四分位间距）随访时间为 6.3（3.2-9.8）年。排除活体捐赠禁忌证的 9364 名第三次全国健康和营养检查调查（NHANES III）参与者构成了一个匹配队列。

主要结局指标：手术死亡率和长期生存率。

结果：在研究期间，活体肾捐献后 90 天内有 25 例死亡。活体肾捐献的手术死亡率为每 10000 名供者 3.1 例（95%置信区间[CI]，2.0-4.6），尽管实践和选择存在差异，但在过去 15 年中并未发生变化。男性的手术死亡率高于女性（每 10000 名供者中 5.1 例比 1.7 例；风险比[RR]，3.0；95%CI，1.3-6.9；P=.007），黑人和西班牙裔个体的手术死亡率高于白人和非西班牙裔个体（每 10000 名供者中 7.6 例比 2.6 例和 2.0 例；RR，3.1；95%CI，1.3-7.1；P=.01），高血压个体的手术死亡率高于无高血压个体（每 10000 名供者中 36.7 例比 1.3 例；RR，27.4；95%CI，5.0-149.5；P <.001）。然而，与年龄和合并症相匹配的 NHANES III 参与者相比，所有患者以及按年龄、性别和种族分层的活体供者的长期死亡风险均无显著增加。

结论：在中位随访 6.3 年后，与健康匹配队列相比，活体肾供者队列的死亡率无显著升高。